Lafayette, LA – In the rolling hills of Pineville, Louisiana, where the stately oak trees have stood for over a century, the remnants of the Central Louisiana State Hospital’s historic campus tell a story of a bygone era. Once home to more than 3,000 patients, the hospital was the last remaining state-run facility in Louisiana dedicated to non-criminal mental health care. Today, it lies largely abandoned, overtaken by vines and echoes of the past. Its closure, along with the shuttering of most state-run mental institutions, marked a dramatic shift in Louisiana’s approach to mental health care — one that has left the state grappling with the consequences.
The decline of state psychiatric hospitals in Louisiana mirrors a national trend that began in the 1960s and accelerated in the 2000s. Under the leadership of Governor Kathleen Babineaux Blanco in the early 2000s, Louisiana began evaluating the viability of its state-run mental health institutions, ultimately deciding to move away from institutional care in favor of community-based services. This shift was part of a larger movement across the United States to close large psychiatric hospitals, a trend that reached its peak under President John F. Kennedy’s administration. The philosophy behind this change was to provide more humane, patient-centered care outside of large institutions, and to save state resources by decentralizing services.
However, in Louisiana, this transition was anything but smooth. As the state closed Central Louisiana State Hospital in 2016 and other facilities before it, the promised community-based care system failed to materialize in a way that could effectively support the population it was meant to serve.
At its height, Central Louisiana State Hospital was one of the largest psychiatric institutions in the state, offering care to people with chronic mental illness, many of whom had nowhere else to turn. The sprawling campus, which included therapeutic spaces such as a greenhouse where patients could engage in gardening, symbolized the institutional approach to mental health care that prevailed throughout much of the 20th century. But by the time it closed, the hospital had become a symbol of a healthcare model that was considered outdated and, in some ways, inhumane.
Governor Jindal’s administration accelerated the closure of state-run hospitals in the early 2010s as part of a broader cost-cutting initiative. The state transitioned to privatizing mental health services, with facilities like Northlake Behavioral Health System in Mandeville taking on the role of providing care that had once been delivered in state hospitals. Jindal’s health secretary at the time, Alan Levine, argued that these closures were part of a larger restructuring effort, which included a focus on expanding outpatient services and increasing the capacity of private hospitals to meet the growing demand for care. The aim, according to Levine, was to create a more modern, efficient system that would better address the state’s mental health needs.
But the results of this transition have been mixed, and the gaps in the system are painfully evident. While the focus on outpatient care and privatization may have saved the state money, it has not led to a more comprehensive or accessible mental health care network. Many patients with chronic mental health issues have found themselves trapped in cycles of homelessness, emergency room visits, or incarceration, with few options for long-term inpatient care.
Louisiana is currently under a consent decree following a lawsuit by the U.S. Department of Justice, which alleged that the state was improperly warehousing people in nursing homes who were in need of mental health care. The state is also facing a lawsuit from the Southern Poverty Law Center over its failure to provide adequate mental health services for young people. Many of these individuals are sent to out-of-state facilities, hours away from their families and communities, further exacerbating the mental health crisis in Louisiana.
Local mental health services, such as those provided by human services districts like the Acadiana Area Human Services District (AAHSD), have stepped in to fill the gaps. These districts now handle much of the state’s outpatient mental health care, offering services like same-day mental health assessments, counseling, and medication management. But they have done so with limited state support. Despite serving thousands of individuals annually, AAHSD’s budget has remained largely stagnant since its inception nearly two decades ago, even as demand for services has grown.
Brad Farmer, executive director of AAHSD, explained that local governing entities (LGEs) like his have taken on a greater role in mental health care simply because they understand the needs of their communities better than the state. But the lack of funding has made it difficult to meet the growing demand. “If we’re in a budget crunch in the state, there’s really only going to be two things that are possible to decrease: higher education and healthcare,” Farmer said. This limited funding has forced the district to scale back in certain areas and reduce its workforce through attrition.
Meanwhile, the privatization of facilities like Northlake Behavioral Health has been met with criticism. Although these privatized hospitals are meant to serve as the state’s safety-net providers, they have faced concerns about patient safety and care quality. Northlake, for example, has received multiple federal citations related to safety violations, raising questions about the adequacy of the care being provided. However, the state has been reluctant to take action against these facilities, in part because they are seen as essential components of the state’s shrinking mental health system.
The decline of state-run psychiatric hospitals like Central has also led to a loss of long-term care options for individuals with severe mental illness. Richard Kramer, the former director of two state hospitals closed under the Jindal administration, pointed out that while patients should not be institutionalized for life, the lack of resources for those requiring long-term care has created a dangerous gap in the system. “There’s not really any support for people beyond acute hospitalization,” Kramer said.
The state’s mental health crisis has been compounded by the broader social issues facing Louisiana. In 2021, nearly half of Louisiana residents reported experiencing symptoms of anxiety or depression, according to the National Alliance on Mental Illness (NAMI). Louisiana also has one of the highest suicide rates in the nation, and the opioid crisis has taken a heavy toll on communities across the state. Without a robust system of mental health care, many individuals are left to navigate a fragmented system that provides few options for sustained support.
As the state continues to rely on a patchwork system of outpatient services, private hospitals, and human services districts, the question remains: What will happen to those who need long-term care? For some, the answer is homelessness, incarceration, or worse. The loss of facilities like Central Louisiana State Hospital has left Louisiana with a glaring absence of options for individuals with chronic mental health conditions, and while local providers like AAHSD are doing what they can, the overall system remains underfunded and overstretched.
As local preservation consultant Paul Smith reflects on the former Central Hospital campus, he notes that the idea behind the institution’s construction was to isolate patients from the broader community, creating a “world for them.” That world, he acknowledges, is no longer viable — but the question remains: What is the replacement? The state’s current approach is still evolving, but without a comprehensive, well-funded system of care, many are left to wonder whether Louisiana is doing enough to address the mental health crisis at its core.
“Hopefully, few people need to be institutionalized,” said Holly Howat, executive director of Beacon Community Connections. “But we have to have some place for people to be. If you don’t offer that, you’re going to have them homeless or in jail.”